Proportion of Uninsured U.S. Residents Grew by 5.8% in 2002, Census Bureau Says

The number of people in the United States without health insurance last year increased by 2.4 million, or 5.8%, to 43.6 million people since 2001, according to figures released Monday by the U.S. Census Bureau, the Wall Street Journal reports. The numbers are likely to add "fuel to the growing debate about both the cost and availability of health care," according to the Journal (Schaefer/McGinley, Wall Street Journal, 9/30). The proportion of U.S. residents who were uninsured in 2002 was 15.2%, compared with 14.6% in 2001, the New York Times reports (Pear, New York Times, 9/30). That increase is the "steepest since the recession of the early 1990s, when the percentage of uninsured also hovered around 15%," the Philadelphia Inquirer reports (Pugh, Philadelphia Inquirer, 9/30). Much of the increase is because of job loss and thus lost health coverage as a result of a slowed economy; employers' dropping coverage because of cost increases; and employees' not enrolling in employer-sponsored coverage because of the rising cost of premiums, according to USA Today (Appleby, USA Today, 9/30). Growing enrollment in Medicaid and SCHIP programs helped keep the total number of uninsured from increasing even more, according to the report (Kemper, Los Angeles Times, 9/30). The proportion of people covered by public health programs -- primarily Medicaid and SCHIP -- increased from 25.3% in 2001 to 25.7% last year (Wall Street Journal, 9/30). Medicaid and SCHIP enrollment increases offset a decline in the number of children in families with private insurance. The proportion of uninsured children decreased last year to 11.6% (Los Angeles Times, 9/30). The figures also show that more residents lack insurance in California than in any other state: 6.4 million Californians, or 18.2% of the state's population, are uninsured (Colliver, San Francisco Chronicle, 9/30).

The Medicaid and SCHIP enrollment increases were "not enough to offset the [overall] decline in private coverage," the report said. Last year, the number of U.S. residents with employer-sponsored insurance dropped by 1.3 million to 175.3 million, or 61.3%, from 62.6% in 2001, while the total population grew by 3.9 million. The number of uninsured full-time workers increased by 897,000 last year to 19.9 million. In addition, 49% of full-time workers living in poverty were uninsured, according to the report. At companies with fewer than 25 employees, 30.8% of the workers had employer-sponsored health insurance, a decrease from 31.3% in 2001. At companies with 25 to 99 employees, the proportion of workers with employer-sponsored health insurance fell by 2.4 percentage points to 54.4%. There also was a decline in proportion of insured workers at companies with more than 1,000 employees, which experienced a 0.9 percentage point drop to 68.7% of workers who were insured last year (New York Times, 9/30).

The report, based on an annual survey of 78,000 U.S. households by the Census Bureau, also includes details about the uninsured in 2002 based on the following categories:

• Geography: The proportion of uninsured in 2002 "varied widely" by state, from lows of about 8% in Minnesota, Rhode Island and Wisconsin, to a high of 24.1% in Texas, the Inquirer reports (Philadelphia Inquirer, 9/30). About 11.7% of Midwest residents were uninsured in 2002, compared with 13% in the Northeast, 17.1% in the West and 17.5% in the South (New York Times, 9/30). According to the report, the percentage of uninsured grew in 18 states last year (Philadelphia Inquirer, 9/30).
  
  
• Sex: Men, who accounted for 66% of the increase in the number of uninsured, were more likely to be uninsured than women in 2002 because they were more likely to lose employer-sponsored coverage, the New York Times reports. The number of uninsured men increased by 1.6 million to 23.3 million in 2002, while the number of uninsured women increased by 761,000 to 20.2 million in 2002 (New York Times, 9/30).
  
  
• Ethnicity: The proportion of uninsured Hispanics was 32.4% last year, unchanged from 2001 and a higher percentage than that of any other racial or ethnic group, the Journal reports (Wall Street Journal, 9/30). The proportion of uninsured blacks in 2002 was 20.2%, compared with 18.4% for Asians and 10.7% for non-Hispanic whites (Philadelphia Inquirer, 9/30). The proportion of uninsured foreign-born individuals was 33.4% last year, compared with 12.8% for U.S.-born individuals (Wall Street Journal, 9/30). About 43% of noncitizens, or 8.9 million people, and 17.5% of naturalized citizens were uninsured in 2002, according to the report (New York Times, 9/30).
  
  
• Income: The number of households with annual incomes between $25,000 and $49,999 declined by about 300,000, but the number of uninsured people in that income category rose by 1.1 million people, or 1.5% in 2002, the Los Angeles Times reports (Los Angeles Times, 9/30). The number of uninsured individuals in households with annual incomes of $75,000 or more increased by 633,000, the second-largest increase, USA Today reports (USA Today, 9/30). The number of uninsured individuals with household incomes lower than $25,000 increased only slightly -- mostly because of a greater number of such households, the Los Angeles Times reports (Los Angeles Times, 9/30). However, households in the under-$25,000-annual-income category, who are likely to be eligible for Medicaid, accounted for the most uninsured by household income in 2002, USA Today reports (USA Today, 9/30). Among households with annual incomes below $25,000, 23.5% were uninsured in 2002, compared with 8.2% of households with annual incomes of $75,000 or more (San Francisco Chronicle, 9/30).
  
  
• Age: The Journal reports that young adults were the least likely of any age group to be insured, with 29.6% not having health insurance last year, an increase from 28.1% in 2001. Health analysts said that the increase is because younger adults are having a more difficult time finding jobs and because many younger workers are opting out of employer-sponsored health plans, as employees' contributions are increasing, according to the Journal (Wall Street Journal, 9/30). However, the Los Angeles Times reports that analysts found it "[m]ost disturbing" that the proportion of nonelderly adults with private insurance -- either employer-sponsored or bought independently -- fell from 73.7% to 72.2%, with only a "small fraction" of those subsequently receiving coverage through Medicaid. As a result, the number of nonelderly adults without insurance increased by more 2.3 million (Los Angeles Times, 9/30). Because of Medicare, 99.2% of seniors have health insurance, CongressDaily/AM reports (Heil, CongressDaily/AM, 9/30).
  

John Holahan, director of the Urban Institute's health policy research center, said, "Even in the mid-90s when the number of uninsured went up, it wasn't going up this much" (Wall Street Journal, 9/30). Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured and executive vice president of the Kaiser Family Foundation, said, "These numbers are a real wake-up call to the fact [that] lack of insurance is a growing problem in the United States" (Connolly, Washington Post, 9/30). "This is no longer an issue of altruism on behalf of a discredited and disadvantaged population. It is now a concern of self-interest for middle-class and working families," Ron Pollack, executive director of Families USA, said (Philadelphia Inquirer, 9/30). "We're seeing now ... people at higher levels of income and more people who worked during the previous year who are experiencing higher uninsured rates," report co-author Robert Mills, a Census Bureau survey statistician, said (Marshall, Long Island Newsday, 9/30). Dr. Donald Young, president of the Health Insurance Association of America, said, "Affordability remains the No. 1 reason people lack health coverage today" (Los Angeles Times, 9/30).

Kate Sullivan, director of health care policy at the U.S. Chamber of Commerce, said that number of uninsured workers would continue to grow, adding, "Workplace coverage is becoming unaffordable for many employers and employees" (New York Times, 9/30). Paul Ginsburg, president of the Center for Studying Health System Change, said that the report will put added pressure on lawmakers to consider "more far-reaching" health care proposals, USA Today reports (USA Today, 9/30). "Reducing the number of uninsured in America is a complex problem that requires a comprehensive solution," HHS Secretary Tommy Thompson said, adding that Congress should support President Bush's plan to give the uninsured tax credits to help them buy health insurance and give more funding to health care facilities that treat uninsured individuals (CongressDaily/AM, 9/30). Claire Buchan, a White House spokesperson, said that Bush is "committed to getting the economy growing faster so the number of unemployed and uninsured Americans will go down" (Washington Post, 9/30). "This issue, just as in 1991 and 1992, will get more and more attention," particularly as the 2004 presidential election approaches, Chris Jennings, health care adviser to former President Clinton, said (Wall Street Journal, 9/30). Sen. Max Baucus (D-Mont.) said that he is working with Sen. Charles Grassley (R-Iowa) on a bill that would offer tax credits to unemployed workers to buy certain types of health insurance. "We have long known the problem of the uninsured is serious. This week's data show that it's getting worse," Baucus said (New York Times, 9/30). "Congress needs to show the same commitment to addressing [the problem of the uninsured] as it has to delivering a prescription drug benefit in Medicare," Grassley said (CongressDaily/AM, 9/30).

Summaries of several feature articles that examine the issue of the uninsured appear below.

• "Census Figures on Uninsured by States": The AP/Las Vegas Sun on Monday examined the two-year averages for the percentage of residents in each state who did not have health insurance for the full year of 2000 to 2001 and 2001 to 2002. Texas had the highest rate of uninsured residents; 23.2% Texas residents did not have health insurance in 2000 to 2001, and 24.7% did not have coverage in 2001 to 2002 (AP/Las Vegas Sun, 9/29).
  
  
• "Boiling Brew: Politics and Health Insurance Gap": The New York Times on Tuesday examines the issue of the uninsured, which has become "politically potent." Health care costs continue to increase, and many U.S. residents have lost health coverage in recent years through layoffs, which has made the issue of the uninsured more of a "middle-class issue," according to the Times (Toner, New York Times, 9/30).
  
  
• "Wal-Mart Cost-Cutting Finds a Big Target in Health Benefits": The Wall Street Journal on Tuesday examines efforts by Wal-Mart to reduce health care costs. Wal-Mart, the nation's largest private employer, requires new hourly employees to wait six months before they can receive health benefits, offers health coverage with deductibles as high as $1,000, refuses to pay for some treatments covered by many other companies and does not pay for treatment of pre-existing medical conditions in the first year of coverage. As a result, Wal-Mart last year spent about $3,500 in health care costs per employee with coverage, about 40% less than the U.S. average (Wysocki/Zimmerman, Wall Street Journal, 9/30).
  
  
• "More Companies That Self-Insure Get Stuck With Huge Medical Bills as Plans 'Laser' Sickest Workers": The Wall Street Journal on Tuesday examines "lasering," a practice used by health insurers to shift to employers the cost of coverage for the sickest employees of self-insured companies. Most self-insured companies cover the cost of health care for employees but obtain stop-loss coverage from health insurers to protect them against catastrophic claims. However, some health insurers have begun to eliminate coverage for employees with severe illnesses (Windham, Wall Street Journal, 9/30).
  
  
• "Young Adults Take Gamble Forgoing Insurance": The Wall Street Journal on Tuesday examines the large number of adults ages 18 to 24 who do not obtain health insurance. According to the Journal, many young adults have a "feeling of invincibility" and "paltry bank accounts," and as a result, about 40% of recent college graduates do not obtain health insurance in the first year after graduation (Windham, Wall Street Journal, 9/30).
  

NPR's "Morning Edition" on Tuesday reported on the census bureau figures. The segment includes comments from Dr. Paul Fronstin of the Employee Benefit Research Institute, National Center for Policy Analysis President John Goodman and Pollack (Rovner, "Morning Edition," NPR, 9/30). The full segment is available online in RealPlayer. In addition, "Morning Edition" on Tuesday interviewed Uwe Reinhardt, a professor of political economy at Princeton University, about the consequences of 15% of the U.S. population living without health insurance. Reinhardt also discussed legislation (SB 2) passed this month by the California Legislature that would require businesses with 50 or more employees to offer health insurance or pay into a fund that would provide such coverage (Edwards, "Morning Edition," NPR, 9/30). The full segment is available online in RealPlayer.